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General NPI Number Information
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NPI Number | 1437053733
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Entity Type | Organization
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Legal Business Name | REVIVAL HEALTH MANAGEMENT LLC
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 30 VREELAND DR STE 2
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City | SKILLMAN
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State | NJ
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Zip | 08558-2637
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Country | US
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Telephone | 646-529-4655
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Fax |
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Provider Business Mailing Address
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Address Line | 30 VREELAND DR STE 2
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City | SKILLMAN
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State | NJ
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Zip | 08558-2637
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF COMPLIANCE OFFICER
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Name | KAYLA ROJAS
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Credential |
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Telephone | 206-898-5432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | NULL
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